0000905718-16-001023.txt : 20160104 0000905718-16-001023.hdr.sgml : 20160104 20160104152014 ACCESSION NUMBER: 0000905718-16-001023 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20160104 DATE AS OF CHANGE: 20160104 EFFECTIVENESS DATE: 20160104 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Clover Health Investments, Corp. CENTRAL INDEX KEY: 0001661101 IRS NUMBER: 471435489 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-254414 FILM NUMBER: 161317883 BUSINESS ADDRESS: STREET 1: HARBORSIDE FINANCIAL CENTER, PLAZA 10 STREET 2: 3 SECOND STREET, SUITE 803 CITY: JERSEY CITY STATE: NJ ZIP: 07311 BUSINESS PHONE: 201-821-8758 MAIL ADDRESS: STREET 1: HARBORSIDE FINANCIAL CENTER, PLAZA 10 STREET 2: 3 SECOND STREET, SUITE 803 CITY: JERSEY CITY STATE: NJ ZIP: 07311 D 1 primary_doc.xml X0707 D LIVE 0001661101 Clover Health Investments, Corp. HARBORSIDE FINANCIAL CENTER, PLAZA 10 3 SECOND STREET, SUITE 803 JERSEY CITY NJ NEW JERSEY 07311 201-821-8758 DELAWARE None None Corporation true 2014 Vivek Garipalli Harborside Financial Center, Plaza 10 3 Second Street, Suite 803 Jersey City NJ NEW JERSEY 07311 Executive Officer Director Josh Kopelman Harborside Financial Center, Plaza 10 3 Second Street, Suite 803 Jersey City NJ NEW JERSEY 07311 Director Nat Turner Harborside Financial Center, Plaza 10 3 Second Street, Suite 803 Jersey City NJ NEW JERSEY 07311 Director Kris Gale Harborside Financial Center, Plaza 10 3 Second Street, Suite 803 Jersey City NJ NEW JERSEY 07311 Executive Officer Director Mike Dixon Harborside Financial Center, Plaza 10 3 Second Street, Suite 803 Jersey City NJ NEW JERSEY 07311 Director Health Insurance Decline to Disclose 06b false 2015-04-24 false true Series A and A-1 Preferred Stock false 0 12999997 12999997 0 Includes the conversion of certain indebtedness. false 7 0 0 0 true Some of the proceeds may be used for general working capital purposes which may include the payment of salaries and other fees to those listed in Item 3 false Clover Health Investments, Corp. /s/ Vivek Garipalli Vivek Garipalli President 2016-01-04